PDF(Pubmed)
Abstract：
Background: Early discharge following ST-segment-elevation myocardial infarction (STEMI) confers notable advantages for both patients and healthcare systems. However, the adoption of a very early discharge strategy for selected patients remains limited due to safety considerations. We aimed to provide some insight into the safety of a discharge program with a hospital stay lasting <48 h after a primary percutaneous coronary intervention (PCI). Methods: Using a registry of 1105 patients undergoing primary PCI for STEMI in our hospital between January 2015 and October 2023, we enrolled all the patients who had a hospital stay ≤48 h, according to a prespecified institutional protocol. The primary objective was a combined rate of non-fatal stroke, non-fatal acute myocardial infarction, or cardiovascular death within 30 days of discharge. Emergency department visits or hospitalizations due to cardiovascular causes, along with the all-cause mortality, were measured during the same period. Results: A total of 453 (41%) patients were discharged ≤48 h after admission for a STEMI. The mean age was 62.4 (±12.5 years), 24.3% were women, and 17.9% were people with diabetes. Up to 96% of the procedures had been performed through radial artery access, and there were no major vascular complications. Regarding the primary endpoint, there was one event (0.2%; one patient suffered a non-fatal myocardial infarction). There were no cardiovascular deaths or deaths from other causes. Only five patients (1.1%) were re-hospitalized or visited the emergency department due to cardiovascular causes. Conclusions: An early discharge strategy for patients within 48 h of experiencing STEMI and undergoing primary PCI appears feasible and safe.
摘要：
背景：ST段抬高型心肌梗死（STEMI）后的早期出院为患者和医疗保健系统带来了显着的优势。然而,出于安全性考虑,对部分患者采用非常早的出院策略仍然有限.我们旨在为初次经皮冠状动脉介入治疗（PCI）后住院时间<48小时的出院计划的安全性提供一些见解。方法：使用2015年1月至2023年10月在我院接受直接PCI治疗STEMI的1105例患者的注册表，我们招募了所有住院时间≤48h的患者。根据预先指定的机构协议。主要目标是非致命性卒中的综合发生率，非致命性急性心肌梗死,或在出院后30天内心血管死亡。急诊科就诊或因心血管原因住院，连同全因死亡率，在同一时期测量。结果：共有453例（41％）患者在STEMI入院后≤48h出院。平均年龄为62.4（±12.5岁），24.3%是女性，17.9%是糖尿病患者。高达96%的手术是通过桡动脉通路进行的，没有严重的血管并发症。关于主要端点，有1例(0.2%;1例患者发生非致死性心肌梗死).没有心血管死亡或其他原因死亡。由于心血管原因，只有五名患者（1.1％）再次住院或去急诊科就诊。结论：对于STEMI患者在48h内并接受直接PCI的早期出院策略似乎是可行且安全的。
